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Spotting and bleeding Vaginal spotting and bleeding are very common during pregnancy, especially in the first trimester. Even though most women who have a bleed go on to have a perfectly healthy pregnancy, it’s very important to have it checked out. This is because bleeding can sometimes be a sign of more serious pregnancy complications like miscarriage or ectopic pregnancy. ‘In early pregnancy, we tend to treat any bleeding as a threatened miscarriage and we’ll usually do a transvaginal scan (where the probe is placed inside your vagina) to see how your baby is doing,’ says Mr Bruce Ramsay, consultant obstetrician and gynaecologist at Peterborough District Hospital. ‘Nine out of 10 times everything is fine.’Sadly, though, bleeding in early pregnancy can sometimes indicate a more serious problem as Andrea Sutcliff, 37, from Sandy, Bedfordshire found out. ‘I was getting a lot of brown spotting and whenever I sat down I’d get this dull pain low down on my right side.‘I was using a coil and thought I might have an infection so I went to my GP, who sent me straight to the Early Pregnancy Unit. I was shocked to hear that, not only did I have an ectopic pregnancy, but I would have to have a fallopian tube removed,’ says Andrea, mum to Scott, 17 weeks. ‘I was really worried when I got pregnant with Scott, but luckily I had no problems whatsoever.’Later in pregnancy, bleeding or spotting is more likely to be a sign of placenta problems.‘If a woman comes to us with bleeding after 20 weeks, the first things we rule out are placental abruption (where the placenta comes away from the womb) and placenta praevia (where the placenta is blocking the cervix),’ says Mr Ramsay.‘Sometimes women have a bleed after sex and that needs checking out to see if there’s an underlying problem, such as an infection or a low-lying placenta,’ he adds. ‘However, by far the majority of bleeding episodes fall into the category of “just one of those things”.’Abdominal pain‘It’s normal to feel a bit crampy and uncomfortable when you’re first pregnant,’ says M&B expert and midwife Helen O’Dell. ‘But if you get a pain that takes your breath away or it’s persistent or getting stronger, phone your midwife or GP straightaway. It could be a sign of miscarriage or ectopic pregnancy, especially if you’ve got bleeding as well.’ Later in pregnancy abdominal pain can be caused by Braxton Hicks (practice) contractions or by overstretched ligaments under your bump. However, it can also signal more serious problems, such as HELLP syndrome, which is a complication of the serious pregnancy condition pre-eclampsia. ‘At 30 weeks I got a pain just under my ribcage that was different to any pain I’d ever had,’ says Annika Mitchell, 27, from Portstewart in Northern Ireland.‘I didn’t have any protein in my urine and my blood pressure was normal so I just put it down to heartburn.’After three days in pain, Annika went to hospital where blood tests showed that she had HELLP syndrome, which can be life-threatening to both mother and baby. ‘I was delivered the same day,’ says Annika, mum to Sam, two. ‘I’m 34 weeks pregnant with our second child now, and this time I’m being watched incredibly closely.’Leaking from your vaginaA gush of amniotic fluid at 37 weeks or after is the first sign of labour for some women (see Is this the big one?, below). Before 37 weeks it can be a sign of premature labour. ‘You can tell the difference between a urine leak and an amniotic fluid leak because you can control a urine leak by tightening your pelvic floor muscles,’ says midwife Helen O’Dell. She adds: ‘Before 37 weeks, you should phone the labour ward immediately. If you are more than 35 weeks and you don’t have any signs of infection we’ll probably tell you to take your time coming in. Before 35 weeks we’d want you in straightaway.’ItchingItchy skin is very common in pregnancy. However, severe, persistent itching in later pregnancy – particularly on the palms of your hands and soles of your feet – needs to be checked out by your midwife or doctor because it can be a sign of a serious pregnancy-related liver condition called obstetric cholestasis.
Claire Taylor, 27, from Letchworth Garden City is mum to Dominic, four, Eva, two and Jonathan, 13 weeks.She says: ‘When I was about 36 weeks pregnant with Eva the palms of my hands and the soles of my feet got really itchy and my urine was a funny dark colour, too. I remember lying awake at night scratching my hands and rubbing my feet on the carpet thinking, “This isn’t normal”.’‘In the end I phoned the birth centre where I was planning to give birth,’ says Claire. ‘They told me to come in immediately and blood tests showed I had obstetric cholestasis. I was induced the next day and, thankfully, Eva was fine.’SwellingSwelling in the hands, feet and ankles is very common in later pregnancy, especially if you’re heavily pregnant in the middle of summer. But occasionally it can be a sign of pre-eclampsia. ‘On it’s own, swelling is not usually an issue,’ says Helen O’Dell. ‘But if you’re having headaches or you know that your blood pressure is raised it could be a sign of pre-eclampsia, so do get it checked out.’Mr Ramsay agrees: ‘Facial oedema (swelling) in particular can indicate pre-eclampsia, so if people start saying you look like a hamster, do get your blood pressure and urine checked.’ HeadachesLots of mums-to-be get headaches in the early weeks of pregnancy. Paracetamol at the recommended dose should help ease these early headaches, but headaches later in pregnancy can signal danger. ‘Headaches in late pregnancy can be a sign of pre-eclampsia, particularly if they are accompanied by visual disturbances,’ says Mr Ramsay. ‘If they persist, despite taking paracetamol, do contact your doctor or midwife.’If you just don’t feel right…If you’ve been lying awake at night wondering whether to bother your midwife about that tummy twinge or those headaches you’ve been having, pick up the phone, says Helen O’Dell: ‘It doesn’t matter how small it is, if you’re worried about something, seek advice.’Is this the big one?Is this another pregnancy niggle or are you in labour? Here’s how to tell: • Back pain – for lots of women, persistent lower back pain is a sign that labour’s about to start. • Vaginal discharge – a blob of brownish or blood-tinged mucus in your knickers is known as a ‘show’ and usually means that labour is imminent. • Leaking fluid – nine out of 10 women whose waters break before labour start having contractions within 24 hours. • Diarrhoea – if you didn’t eat in a dodgy curry house last night, it’s probably Mother Nature clearing out your bowels ready for labour.• Tummy cramps – if the cramps are happening regularly and at increasingly shorter intervals then, yep, your baby’s on the way.
Support• Obstetric Cholestasis Support• Action on Pre-Eclampsia• Miscarriage Association• Ectopic Pregnancy Trust
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